Provider Demographics
NPI:1811931736
Name:HESS, RANDELL LOUIS (MSW)
Entity type:Individual
Prefix:MR
First Name:RANDELL
Middle Name:LOUIS
Last Name:HESS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 DODGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121-1209
Mailing Address - Country:US
Mailing Address - Phone:504-835-6450
Mailing Address - Fax:504-835-6451
Practice Address - Street 1:300 CODIFER BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-3777
Practice Address - Country:US
Practice Address - Phone:504-835-6450
Practice Address - Fax:504-835-6451
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9271041C0700X
LA872106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
S26021Medicare UPIN
LA5S177Medicare ID - Type Unspecified